What Your Practice Needs to Know About the LEIE Database

When a provider has been banned from receiving payments from Medicaid, Medicare, and other federal medical insurance programs, they are added to the List of Excluded Individuals/Entities (LEIE). The database was established in 1977 and is managed by Health and Human Services (HHS) Office of the Inspector General (OIG). It is critical that healthcare entities check the database to see if current employees, potential new hires, and contractors are entered into the database. Failure to conduct that check could have serious legal and financial consequences.

Who Is On the LEIE?

There are two categories for provider exclusions. Mandatory exclusions are those that are legally required and are added because the provider has been convicted of a felony. The types of crimes include:

• Medicaid or Medicare fraud

• Conviction of a felony-level offense related to federal or state medical insurance programs

• Conviction of a felony-level offense related to controlled substances

• Convictions for patient abuse or neglect

The second category is permissive exclusions. These are for misdemeanor convictions and it is up to the discretion of the OIG whether or not the provider should be added to the list.

What Are the Potential Consequences if a Provider Fails to Check the LEIE?

As mentioned above, the failure of a healthcare provider or entity to check to see if an employee is on the LEIE list can be costly. In fact, filing any claims with a federal medical insurance program for services rendered by an excluded provider can result in charges of medical insurance fraud.

This is what recently happened to one psychiatric practice and its owner. The Department of Justice recently announced the owner had agreed to pay the government more than $310,000 to settle allegations that the practice hired a doctor who was on the OIG’s LEIE list and therefore excluded from participating in any federal health care programs. Because the doctor was excluded, the DOJ’s position was that any claims for services the doctor provided that were filed with any government health care insurance programs were illegal under the False Claims Act (FCA).  

Not knowing a provider is on the exclusion list is not a defense for an employer if they are caught filing claims. It should be well understood that the OIG does not send out notices or warnings when a provider is added to the database. That is why it is so critical that healthcare organizations conduct a thorough search of the database whenever they are considering a new hire. It is also important to make sure that no current employees are in the database.

Contact an Indiana Professional Licensing Lawyer

If you are a healthcare provider and have been notified that one of your employees is on the LEIE, you could be facing serious civil penalties. Call The Law Offices of Joseph J. Bogdan, LLC at 463-219-2612 to schedule a consultation with an Indiana loss of status attorney and find out what your legal options may be.

Sources:

https://www.justice.gov/usao-ct/pr/hamden-psychiatric-practice-and-its-owner-pay-310k-employing-excluded-individual

https://oig.hhs.gov/exclusions/